…Where’s D?

Vitamin D has been called the “sunshine vitamin” since the body makes the nutrient only when it is exposed to sunlight. For African American and Hispanic children, making vitamin D is a bit more challenging. The increased melanin in their skin reduces the body’s ability to make vitamin D. Not surprisingly, recent studies have shown that many children living in the north have low vitamin D levels. But new research has shown that even in sunny climates, African American and Hispanic children are still at increased risk for deficiency.

Emory pediatrician Conrad Cole looked at vitamin D levels in Hispanic and African American children, mostly from low-income families in Atlanta. The average age of the children was 2½ years.

He found that 22% of the children had low levels of vitamin D3, and 74% had less than optimal levels of 25-hydroxyvitamin D. Vitamin D levels were lower in children during fall and winter than spring and summer.

Things made for adults don’t always fit children

Take dialysis equipment, for example. For children needing kidney dialysis, doctors are forced to adapt adultsized dialysis equipment, which can cause complications. But children may eventually have a kidney-replacement device especially for them.

Researchers from Emory, Children’s Healthcare of Atlanta, and Georgia Tech are developing what could be the first FDA-approved kidney replacement device for children. They were awarded a $1 million grant from the NIH to refine a prototype.

“The adaptations doctors are forced to perform make adult kidney replacement devices inaccurate and potentially dangerous when used with kids,” says Emory pediatrician Matthew Paden, the grant’s principal investigator. “We have invented a new continuous renal replacement therapy device that can be used accurately on a six-pound child all the way up to a football linebacker.”

Adult equipment can withdraw too much fluid from a child, leading to dehydration and loss of blood pressure. The volume of blood required to fill up the tubes leading to and from the apparatus is too large—the smaller the child, the larger the proportion of blood outside the body, Paden says.

The team is testing their prototype in the laboratory and hopes to be ready for clinical trials in five years.

The greatest deficiency was among African American children, 26%, compared with 18% of Hispanic children. More Hispanic children drank milk fortified with vitamin D, which provided most of their needed vitamin D intake, he says.

“Although most young children are known to be deficient in vitamin D, children from low-income families are likely to be at highest risk of developing nutrient deficiencies because of social and economic factors,” Cole says.

New pediatric research building is planned

A new $90 million pediatric research building is expected to open on the Emory campus in December 2012, pending final approval by Emory’s board of trustees. The four-story building will be located on the corner of Haygood Drive and Andrews Drive, across the street from the Emory-Children’s Center. A planned two-story bridge will connect the two buildings.

The 200,000-sq.-ft. Health Sciences Research Building will be largely devoted to pediatrics.

Intraocular lenses for babies carry risks

It’snot an easy feat to put a contact lens in a baby’s eye but a necessary one for parents of infants who have undergone cataract removal surgery and need a replacement lens. A cataract clouds the eye’s natural lens and prevents the eye from focusing. Without a replacement lens following surgery, a baby’s eye would lose its ability to see.

Contact lenses usually are recommended for babies, but for school-age children who develop a cataract, an intraocular lens (IOL) is implanted into the eye because it offers better visual sharpness. IOLs, though, carry a higher rate of complications, and for that reason, ophthalmologists typically don’t use them for infants.

But Emory ophthalmologist Scott Lambert wanted to know if potential risks for IOLs in infants would be offset by a significant improvement in vision. He recently led a national study to determine which treatment for aphakia (absence of the eye’s natural lens) is better for infants who were born with a cataract in one eye. The infants in the study were aged 4 weeks to 7 months.

“Intraocular lenses have become the standard means of focusing the eyes of adults and older children after cataract surgery,” says Lambert. “However, the eyes of babies behave quite differently from adult eyes after cataract surgery.”

In adults, the timing of cataract surgery won’t affect their long-term vision. But delaying surgery in babies can cause permanent vision loss.

Lambert and his team tracked the infants for one year after surgery and found no difference in vision between those with a contact and those with an IOL. However, for IOLs, the rate of complications during surgery was three times higher and additional surgeries, five times higher, than for contacts.

Ophthalmologists plan to test the children’s vision at age 4 to determine if there is a long-term visual benefit to IOLs.

$5 million gift to address fundamental needs

New york philanthropist Margaretta Taylor recently gave $5 million to the medical school to support primary care, student scholarships, and faculty recruitment.

One-fifth of the gift will create an endowment, the Margaretta Taylor Clinician Fund in Primary Care, to support a primary care doctor. Emory internist Sally West has been named the first Taylor Clinician.

The remaining $4 million will be used to name the lobby of the James B. Williams Medical Education Building, help support priorities such as student scholarships, recruitment of clinicians, and retention packages for faculty.

The Williams building was named last year for Emory trustee emeritus James Williams 55C, retired chairman of SunTrust Banks, for his 35 years of service to the university.

Taylor decided to invest in the medical school because of its “great achievements and unlimited potential” in education, patient care, and research, she says.

Behind the scenes

Fred Sanfilippo will step down September 1 as Emory executive vice president for health affairs, CEO of the Woodruff Health Sciences Center (WHSC), and chairman of the Emory Healthcare board. Sanfilippo joined Emory in 2007 from Ohio State University, where he was Medical Center CEO and executive dean for health sciences.

Wright Caughman, director of The Emory Clinic, will serve as interim head of WHSC, while cardiologist Douglas Morris, director of the Emory Heart & Vascular Center, will serve as interim head of the clinic.